Critical care : the official journal of the Critical Care Forum
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Randomized Controlled Trial
Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in healthy subjects in a simulated intensive care unit environment: which might be a more promising strategy for ICU sleep deprivation?
Sleep deprivation is common in critically ill patients in the intensive care unit (ICU). Noise and light in the ICU and the reduction in plasma melatonin play the essential roles. The aim of this study was to determine the effect of simulated ICU noise and light on nocturnal sleep quality, and compare the effectiveness of melatonin and earplugs and eye masks on sleep quality in these conditions in healthy subjects. ⋯ Compared with earplugs and eye masks, melatonin improves sleep quality and serum melatonin levels better in healthy subjects exposed to simulated ICU noise and light.
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Multicenter Study
Unexpected death within 72 hours of emergency department visit: were those deaths preventable?
We aimed to determine the rate of preventable death in patients who died early and unexpectedly following hospital admission from the emergency department (ED). ⋯ In our sample, more than half of unexpected deaths are related to a medical error, and could have been prevented.
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A clinical suspicion of infection is mandatory for diagnosing sepsis in patients with a systemic inflammatory response syndrome. Yet, the accuracy of categorizing critically ill patients presenting to the intensive care unit (ICU) as being infected or not is unknown. We therefore assessed the likelihood of infection in patients who were treated for sepsis upon admission to the ICU, and quantified the association between plausibility of infection and mortality. ⋯ This study is the first prospective analysis to show that the clinical diagnosis of sepsis upon ICU admission corresponds poorly with the presence of infection on post-hoc assessment. A higher likelihood of infection does not adversely influence outcome in this population.
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Discharge diagnoses versus medical record review in the identification of community-acquired sepsis.
We evaluated the accuracy of hospital discharge diagnoses in the identification of community-acquired sepsis and severe sepsis. ⋯ Hospital discharge diagnoses show good specificity but poor sensitivity for detecting community-acquired sepsis and severe sepsis. While sharing similar baseline subject characteristics as cases identified by hospital record review, discharge diagnoses selected for higher mortality sepsis and severe sepsis cohorts. The epidemiology of a sepsis population may vary with the methods used for sepsis event identification.
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In low-resource settings it is not always possible to acquire the information required to diagnose acute respiratory distress syndrome (ARDS). Ultrasound and pulse oximetry, however, may be available in these settings. This study was designed to test whether pulmonary ultrasound and pulse oximetry could be used in place of traditional radiographic and oxygenation evaluation for ARDS. ⋯ Pulse oximetry and pulmonary ultrasound may be useful tools to screen for, or rule out, impaired oxygenation or lung abnormalities consistent with ARDS in under-resourced settings where arterial blood gas testing and chest radiography are not readily available.